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Organization

IREDELL PHYSICIAN NETWORK LLC

Active
Parent organization
IREDELL PHYSICIAN NETWORK LLC
Other names
Statesville Family Practice
Organization subpart
Yes

Provider details

NPI number
Legal business name
IREDELL PHYSICIAN NETWORK LLC
Authorized official
CARLA JOHNSON (DIRECTOR OF OPERATIONS)
(704) 873-5661
Entity
Organization

Contact information

Practice address
310 DAVIE AVE, STATESVILLE, NC 28677-5319
(704) 873-3269
(704) 871-8159
Mailing address
PO BOX 896199, CHARLOTTE, NC 28289-6199
(833) 936-1364
(605) 942-7505

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8902748
NC
Enumeration date
05/08/2006
Last updated
10/01/2024
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